According to the AAST organ injury scale, which finding classifies a blunt renal injury as Grade IV?

• A Subcapsular haematoma without parenchymal laceration
• B Parenchymal laceration less than 1 cm deep involving the cortex only
• C Shattered kidney with devascularised parenchyma and active bleeding
• D Laceration extending into the collecting system with urinary extravasation, or segmental renal vessel injury with contained haemorrhage ✓

Explanation

Grade IV renal injury is defined by extension of the laceration into the collecting system with urinary extravasation, or a segmental renal artery or vein injury with contained haemorrhage. Subcapsular haematoma is Grade I and a cortical laceration under 1 cm is Grade II. A shattered kidney or avulsion of the hilum causing devascularisation constitutes Grade V. Most Grade III and IV injuries in stable patients are still managed conservatively.

Reference: Campbell-Walsh Urology, 12th ed.

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